Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study

• Published in: Journal of critical care Vol. 30; no. 3; pp. 537 - 542
• Main Authors: Maseda, Emilio, MD, Suarez-de-la-Rica, Alejandro, MD, Anillo, Víctor, MD, Tamayo, Eduardo, MD, García-Bernedo, Carlos A., MD, Ramasco, Fernando, MD, Villagran, Maria-Jose, MD, Maggi, Genaro, MD, Gimenez, Maria-Jose, PhD, Aguilar, Lorenzo, MD, Granizo, Juan-José, MD, Buño, Antonio, MD, Gilsanz, Fernando, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2015; Elsevier Limited
• Subjects: Abdomen; Aged; Aged, 80 and over; Algorithms; Anti-Bacterial Agents - administration & dosage; Antibiotic treatment duration; Antibiotics; Bacterial infections; Biomarkers; Calcitonin - blood; Calcitonin Gene-Related Peptide; Complicated intra-abdominal infection; Critical Care; Ethics; Female; Hospitals; Humans; Infections; Intensive care; Intensive Care Units; Male; Medical records; Middle Aged; Mortality; Patients; Peritonitis - blood; Peritonitis - drug therapy; Physiology; Procalcitonin; Protein Precursors - blood; Retrospective Studies; Septic shock; Shock, Septic - blood; Shock, Septic - drug therapy; Shock, Septic - mortality; Values; Ventilation; Septic shock; Antibiotic treatment duration; Complicated intra-abdominal infection; Procalcitonin
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.12.014

Abstract Purpose Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs). Methods A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012–June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non–PCT-guided (no notation) groups. Results A total of 121 patients (52 PCT-guided, 69 non–PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non–PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non–PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non–PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ± 2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock. Conclusion Procalcitonin guidance produced 50% reduction in antibiotic duration ( P < .001, log-rank test).